Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
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PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55

The acquired immunodeficiency syndrome (AIDS) is a devastating new disease caused by the human immunodeficiency virus (HIV). This retrovirus causes profound immunoincompetence in its infected hosts, who are thereafter susceptible to develop myriad severe and relapsing protozoal, fungal, bacterial, viral, and arthropodal opportunistic infections, as well as unusual malignancies. The more than 50,000 patients who have developed AIDS in the United States have produced a sudden unexpected deluge of diagnostic dilemmas that are stressing laboratories of pathology everywhere. This paper describes the gross and microscopic pathology of the numerous complications in patients infected by HIV: (a) the prodromal AIDS-related complex with persistent generalized lymphadenopathy, (b) lymphoid infiltration of salivary gland and lung, including the complex of lymphoid interstitial pneumonitis-pulmonary lymphoid hyperplasia, (c) extranodal non-Hodgkin's lymphomas, (d) multifocal mucocutaneous and visceral Kaposi's sarcoma, (e) small cell undifferentiated (oat cell) carcinomas, (f) protozoal infections caused by Pneumocystis carinii, Toxoplasma gondii, Acanthamoeba, Cryptosporidium species (sp.), and Isospora belli, (g) the causes of chronic enteritis, (h) mycotic infections caused by Candida sp., Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, and Sporothrix schenckii, (i) bacterial infections caused by Mycobacterium avium-intracellulare, M. tuberculosis, M. kansasii, Nocardia sp., Listeria monocytogenes, Legionella sp., Treponema pallidum, and others, (j) viral infections caused by cytomegalovirus, herpes simplex and zoster, polyomavirus (progressive multifocal leukoencephalopathy), hepatitis B, molluscum contagiosum, and papillomavirus, (k) oral hairy leukoplakia, (l) subacute encephalopathy, and (m) Norwegian scabies.
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PMID:The pathology of AIDS. 283 78

Attempts to infect horses with Legionella pneumophila were undertaken to determine pathogenicity and to evaluate the possibility that horses serve as a reservoir for the organism. A previous study showed that the prevalence of antibodies to L pneumophila in the equine population exceeded 30% of over 600 sera examined. Horses were infected experimentally with the Philadelphia 1 or Bloomington 2 strain of L pneumophila IV or by aerosolization. Signs of clinical illness were restricted to a transient febrile response. A transient decrease in circulating lymphocytes occurred 2 days after inoculation. At necropsy, only moderate generalized lymphadenopathy was noted. Histologically, the lungs contained evidence of a low-grade inflammatory response characterized by focal proliferation of alveolar lining cells, with few neutrophils and eosinophils. Lymph nodes had evidence of reactive hyperplasia. The tissue response to Bloomington 2 strain was slightly more pronounced than that to Philadelphia 1. Attempts to reisolate L pneumophila from blood and nasal or pharyngeal swabs were unsuccessful. The organism was not isolated by culturing tissues obtained at necropsy, nor was it demonstrated by tissue-staining techniques. However, all horses exhibited a marked increase in agglutinating antibodies to L pneumophila serogroups (SG) 1 and 3 as early as 4 days after inoculation. The serologic response was confirmed by indirect immunofluorescence and was shown to consist predominantly of immunoglobulin M by 2-mercaptoethanol treatment. Agglutinating antibodies persisted at least 4 months after infection. On the basis of these studies, the pathogenicity of L pneumophila SG 1 and 3 for the horse appears to be low. There is no evidence to support a role for the horse in the maintenance of these organisms in nature. Horses may be exposed in the environment and maintain a relatively long-lived serologic response to L pneumophila. However, it is also possible that they become infected with other strains of L pneumophila or Legionella-like organisms more pathogenic for horses, or other non-Legionella bacteria, which elicit a cross-reacting serologic response to L pneumophila SG 1 to 4.
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PMID:Experimental infections of horses with Legionella pneumophila. 686 62

Eight adult patients from Port Elizabeth with significantly raised indirect fluorescent antibody titres of greater than or equal to 256 against the Legionnaires' disease bacterium are described. One of these patients had in addition elevated antibody levels against Mycoplasma pneumoniae. The clinical manifestations of the patients ranged from an 'influenza-like' illness in 1 patient to pneumonia of varying severity in 6. One patient had a severe illness with fever, couth and encephalopathy, together with the uncharacteristic features of lymphadenopathy and a petechial rash. This patient did not have pneumonia. Attention is drawn to unusual clinical aspects in some of the patients and the need for improved definitive diagnostic procedures is emphasized.
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PMID:Legionnaires' disease in Port Elizabeth. 699 44

Legionellosis is an important cause of severe pneumonia in the community. Inadequate therapy will lead to respiratory distress syndrome, disseminated intravascular coagulation (DIC) and finally fatal multiple organ failure. We encountered a rare case in which early manifestation included septic shock and DIC complicated by acute myocardial infarction (AMI) suspected to be derived from Legionnaires' disease. A 54-year-old healthy female complained of lumbago, high fever and dry cough 10 days after visiting a hot spring spa. She was emmergently admitted due to shock. Physical examination demonstrated hypotension, high fever, course creakle in the right lower lung. Hepatosplenomegaly, lymphadenopathy and eruption were not found. WBC count was 34600/microliters with nuclear shift. CRP elevated. FDP, D dimer and TAT also elevated CPK elevated with dominance of the MB isozyme. Chest roentogenography revealed congestive heart failure, pleural effusion and obscure pneumonic shadow and EKG showed ST segment elevation in leads I, II, III, aVF, V4, V5, and V6. The patient was diagnosed as having septic shock, DIC and AMI. She was treated with gabexate mesilate, high dose methyl prednisolone and dopamine hydrochloride as well as piperacillin, meropenem, isepamycin and fluconzaole. Despite intensive care, the blood pressure fell again and pneumonia had progressed on the 8th hospital day. These antibiotics appeared to be ineffective. Erythromycin was then administered and a dramatic effect. was obtained as the patient recovered. Serum titer of Legionella pneumophila (serogroup 1) rose to 128-fold 2 weeks after the onset. Other serum titers such as Chlamydia psittaci, Rickettsia, Mycoplasma were all negative. Cultures obtained from the sputum, throat swab, urine and blood did not yield any microorganisms. Although the diagnosis could not be confirmed because the titer did not elevate over 256-fold of 4-fold within 2 weeks after the onset, Legionella infection was highly suspected from the clinical features. This is a rare case in which septic shock and DIC with AMI preceded pulmonary symptoms in a non-immunocompromised patient.
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PMID:[Early manifestation of septic shock and disseminated intravascular coagulation complicated by acute myocardial infarction in a patient suspected of having Legionnaires' disease]. 958 3

The chest radiograph of Legionellosis has been described in many reports. Although some attempted to describe patterns which are specific for Legionella, in fact, the roentgenographic findings in Legionella infection vary widely and depend largely on when in the course of illness the radiograph is obtained. Certain temporal characteristics, however, can serve to enhance the likelihood of the diagnosis of Legionella pneumonitis. Initial focal infiltrates are most commonly poorly marginated with 10% presenting with concomitant pleural effusion. The infiltrates often spread to contiguous lobes eventually becoming bilateral, with incidence of pleural effusions reaching 35%. This progression often occurs despite appropriate antimicrobial therapy and often in the face of clinical improvement. A similar pattern of progression also occurs in immunocompromised individuals; in addition, a high rate of cavitation and hilar adenopathy is seen in this subset of patients. A prolonged resolution phase of up to 6 months is common with rare development of residual densities. Correlating radiographic features with disease severity and mortality have largely been unsuccessful.
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PMID:Radiological manifestations of Legionella/Legionella-like organisms. 964 88

An index case of Legionnaires's disease with mediastinal adenopathy prompted us to review our recent experience with Legionnaires' disease to determine the incidence of mediastinal adenopathy of this finding in Legionnaires' disease. We reviewed the radiographic findings of 90 hospitalized adults with Legionnaires' disease from 2015 to 2017. Excluded were 11 patients with mediastinal adenopathy due to non-Legionnaires' disease causes, e.g., lymphoma. Thirty-seven of the remaining patients had both chest films and chest computed tomography (CT) scans. Of the 37 Legionnaires' disease cases, 13/37 (35%) had mediastinal adenopathy and 8/27 (24%) also had unilateral hilar adenopathy. These chest CT findings were not seen on chest films. Chest CT scans are needed to detect mediastinal adenopathy in Legionnaires' disease. Mediastinal adenopathy may be due to Legionnaires' disease or a malignancy. Some findings in Legionnaires' disease are also present in mediastinal adenopathy due to lymphomas, e.g., highly elevated erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and ferritin. Hospitalized adults with Legionnaires' disease and mediastinal adenopathy should have serial chest CT scans to monitor resolution of the mediastinal adenopathy. In hospitalized adults with otherwise unexplained persistent mediastinal adenopathy, they should be considered as being due to another etiology, e.g., lymphoma, until proven otherwise.
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PMID:Study of the radiologic features of Legionnaires' disease with mediastinal adenopathy: Legionella or lymphoma? 2938 55